Clinical characteristics of spontaneous late onset comitant acute nonaccommodative esotropia in children
We read the article by Kothari on acute comitant esotropia (ACE) with interest.1 We would like to make a few comments.
We feel that the article has created some confusion regarding the diagnosis of this simple entity and has also needlessly given a new acronym as ANAET. The entity is not as common as the author is trying to highlight. The author probably has overdiagnosed this entity as is evident from his introduction in which he has mentioned five types of this entity which includes even refractive accommodative esotropia. For this he has cited even von Noorden, though that clearly describes only three types of ACE and distinguishes refractive accommodative esotropia from it.23 The refractive accommodative and late onset basic esotropia are both separate entities from ACE. He seems to have included some of the cases of late onset basic esotropia and refractive accommodative esotropia, misdiagnosed as ACE, since the characteristic history of diplopia was not looked for in making this diagnosis. The latest attempt to classify the ocular motility anomalies: Classification of eye movement abnormalities and strabismus (CEMAS) (Report of a National Eye Institute Sponsored Workshop, from the Committee for the Classification of Eye Movement Abnormalities and Strabismus Workshop) unfortunately is quiet about ACE. However, we come across cases of ACE of all the three types described. In fact one should always keep this entity in mind and get an imaging study done to rule out neurological abnormalities.
1. Kothari M. Clinical characteristics of spontaneous late-onset comitant acute nonaccommodative esotropia in children Indian J Ophthalmol. 2007;55:117–20
2. von Noorden GK, Campos EGunter K von Noorden, Emilio Campos. Esodeviations Binocular vision and ocular motility.6th ed USA CV Mosby Company:311–41
© 2007 Indian Journal of Ophthalmology | Published by Wolters Kluwer – Medknow
3. Legmann Simon A, Borchert M. Etiology and prognosis of acute, late-onset esotropia Ophthalmology. 1997;104:1348–52